Provider Demographics
NPI:1699756924
Name:HOFFMAN, BRIAN D (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:HOFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-533-6000
Practice Address - Street 1:7423 S MASON MONTGOMERY RD
Practice Address - Street 2:STE B
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7828
Practice Address - Country:US
Practice Address - Phone:513-398-3445
Practice Address - Fax:513-389-4680
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067362207Q00000X
OH35067362H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108430Medicaid
OH0108430Medicaid
OHHO0813533Medicare PIN
OHP00915558Medicare PIN
OH0813532Medicare PIN
OHF92877Medicare UPIN